Who decides?

When you require medical treatment, who decides if that treatment is covered by health insurers?
Many times, the answer is written in the provisions of the policy. In some times when the answer is not clear, it is a matter of interpretation by the insurer with the opportunity for appeal by the consumer.
Whether and how that changes under health care reform is a matter of considerable debate, with some suggesting the government should decide and others suggesting the need for an independent arbiter.
More than half of U.S. residents polled said they would trust an independent scientific panel to decide which medical treatments insurers should cover, compared with 42% who said they would trust a government health agency to make that decision, according to a recent poll by NPR, the Kaiser Family Foundation and the Harvard School of Public Health, NPR.org reports.
Clarity, consistency and trust are critical if a new process is adopted. Until then, the status quo is a system that consumers and insurers are familiar with and has served its purpose well.

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Individual health insurance, health insurance coverage, health insurance plans, health insurance comparisons, personal health insurance, group health insurance, health insurance options, temporary health insurance, health insurance glossary, COBRA health insurance, health savings accounts (hsa’s).

A growing crisis in delayed care

The number of uninsured and underinsured Americans is taking a predictable, but no less unfortunate, toll on the health of the nation. A Thompson Reuters study out this week finds that one in five Americans have delayed or postponed medical care, and cost is the main reason. That number is up from 16 percent in 2006.

The director of the study says there is a correlation between the loss of employer-sponsored coverage and deferral of healthcare. This has “serious implications for public health officials, hospital administrators and healthcare consumers,” according to Gary Pickens, who directed the study. The percentage of households with employer-sponsored coverage declined from 59 to 54.6 percent over the past year.

In an additional finding, 21 percent of U.S. adults expected to have difficulty paying for health insurance or healthcare services in the next three months.

Frankly, in my work as a consumer lawyer in the recession-riddled Midwest, these numbers seem low and destined to go higher.

What is the solution? Of course, that is the political hot potato of the day. But the answer certainly lies in a broad approach that includes the promotion of individual medical policies for those who can afford them and state-sponsored high-risk pools for those with chronic conditions.

Other SimpleCoverage.org topics:

Individual health insurance, health insurance coverage, health insurance plans, health insurance comparisons, personal health insurance, group health insurance, health insurance options, temporary health insurance, health insurance glossary, COBRA health insurance, health savings accounts (hsa’s).

Roulette with your health and finances

We are all invincible, or at least we like to think we are.

But a recent illustration on our Health Matters policy forum at www.simplecoverage.org illustrates how dangerous this belief may be when it comes to insuring our health.  The danger is not just one of physical well-being, but financial as well.

A simple broken ankle may be enough to break the bank when the costs of emergency treatment, surgery and rehabilitation are considered.  As suggested, a $50,000 medical bill from such an incident is possible.  And that is just a common accident.  Imagine the implications for failing to protect yourself and your family against more catastrophic conditions.

But that is what a growing number of Americans are doing as they forego health insurance and roll the dice with their financial health as well.

That is most unfortunate because, even where group coverage is not available, individual and short-term medical coverage may be.  And it often is surprisingly affordable.  Indeed, an individual policy may be less expensive than COBRA coverage.

Whatever the cost, it is a matter of perception and protection.  A premium that seemed high at one point in time may be a great bargain when that $50,000 broken ankle bill comes due.

Other SimpleCoverage.org topics:

Individual health insurance, health insurance coverage, health insurance plans, health insurance comparisons, personal health insurance, group health insurance, health insurance options, temporary health insurance, health insurance glossary, COBRA health insurance, health savings accounts (hsa’s).

The skinny on pre-existing conditions

One of our viewers at www.simplecoverage.org writes:

“I have a concern over pre-existing conditions as well. Specifically, how long must one be with a carrier before the condition is no longer “pre existing.” Some conditions, like swollen tonsils, are present since a young age and it seems like getting them removed as an adult will always be considered surgery for a pre existing condition.”

Great question, and one of the most misunderstood aspects of applying for individual medical insurance.

Yes, it is correct that most of us have some medical issue that follows us, whether it is tonsillitis or something more serious. What is less understand, however, is that pre-existing conditions don’t necessarily prevent a consumer from getting insurance or even from having that condition covered.

Many routine conditions–simple illnesses and injuries–have not impact at all. Others, which are more chronic or ongoing in nature, often are covered, but the premium may be a bit higher to account for this. Or, as the question suggests, coverage may for a given condition may not be available from a period of time, often a year. Finally, some conditions, may keep a consumer from obtaining coverage.

It is this latter category–uninsurable conditions–that frighten some seeking coverage, even though they tend to to be the exception.

The best approach is simple to provide information honestly and openly, and then let your insurance agent guide on which policy may work.

In the rare case where insurance cannot be written, there may be other options, including a state high-risk pool.

Other SimpleCoverage.org topics:

Individual health insurance, health insurance coverage, health insurance plans, health insurance comparisons, personal health insurance, group health insurance, health insurance options, temporary health insurance, health insurance glossary, COBRA health insurance, health savings accounts (hsa’s).